Provider Demographics
NPI:1841328200
Name:BRONSON, AMANDA JO (M OTR-L)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JO
Last Name:BRONSON
Suffix:
Gender:F
Credentials:M OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1821
Mailing Address - Country:US
Mailing Address - Phone:406-861-2315
Mailing Address - Fax:
Practice Address - Street 1:824 S SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-3022
Practice Address - Country:US
Practice Address - Phone:218-736-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist